Chronic pain: It's time to think outside the box

Researchers are taking a broader view of chronic pain that will allow development of new treatment strategies.

Specifically, pain researchers have introduced the concept that all pain syndromes may share a common central pathway, suggesting that those patients who have these syndromes have a reduced ability to cope with them (see "Clinicians urged to adapt new model of chronic pain" ). At the same time, researchers have not abandoned the concept that pain syndromes may be in part associated with a specific target organ, such as the prostate, bladder, pelvic side wall, or bowel.

For urologists and other specialists, this new model changes how the problem of chronic pelvic pain is perceived, and eventually may change how it is managed. It may lead to goal-directed therapy, which is now used in many men with erectile dysfunction. In the past, urologists focused on pinpointing the cause of ED as vasculogenic, neurogenic, or another etiology. Now, with the availability of effective oral treatments, we are less concerned about a specific cause, as long as the patient is satisfied with his treatment.

Because of the Chronic Pelvic Pain/Chronic Prostatitis Workshop and other conferences, researchers are taking a broader view of chronic pain that will allow development of new treatment strategies. It's clear that novel ways of treating central pain, including drug therapies currently under study, are part of the evolving strategy for dealing with all pain syndromes, including prostatitis and IC.

This is good news for clinicians managing chronic pelvic pain, a field that has little good news to report in recent years. It's time to think, literally and figuratively, outside the box, whether that "box" is the prostate, the bladder, or another pelvic organ. Although we must not abandon our search for specific causes of pain, we should make an effort to understand how the central nervous system plays a role in chronic pelvic pain syndromes.

Dr. Schaeffer, a member of the Urology Times Editorial Council, is professor and chairman of the department of urology, Northwestern University Medical School, Chicago.

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